8/10/2019 TEMS Evaluation Sheet 1.1- Bag-Valve-Mask

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Republic of the Philippines

Cordillera Administrative Region TUBA EMERGENCY MEDICAL SERVICES

Municipality of Tuba

Tuba Emergency Medical Services Evaluation Sheet

BAG-VALVE-MASK APNEIC PATIENT

Name: ______________________________________ Date: __________________

Takes or verbalizes appropriate body substance isolation precautions 1Checks responsiveness NOTE: After checking responsiveness and breathing for at least 5 but no

more than 10 seconds, examiner informs the candidate, ThePatient is unresponsive and apneic.

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1Checks breathing

Requests additional EMS assistance 1Checks pulse for at least 5 but no more than 10 seconds 1

NOTE: The examiner must now inform the candidate, You palpate a weak carotid pulse at a rate of 60. Opens airway properly 1

NOTE: The examiner must now inform the candidate, The mouth is full of secretions and vomitus. Prepares rigid suction catheter 1

Turns on power to suction device or retrieves manual suction device 1Inserts rigid suction catheter without applying suction 1Suctions the mouth and oropharynx 1

NOTE: The examiner must now inform the candidate, The mouth and oropharynx are clear. Opens the airway manually 1Inserts oropharyngeal airway 1

NOTE: The examiner must now inform the candidate, No gag reflex is present and the patient accepts the airwayadjunct.

**Ventilates the patient immediately using a BVM device unattached to oxygen[**Award this point if candidate elects to ventilate initially with BVM attached to reservoir and oxygen so longas first ventilation is delivered within 30 seconds.]

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NOTE: The examiner must now inform the candidate that ventilation is being properly performed without difficulty. Re-checks pulse for at least 5 but no more than 10 seconds 1

Attaches the BVM assembly [mask, bag, reservoir] to oxygen [15 L/minute] 1 Ventilates the patient adequately-Proper volume to make chest rise (1 point)-Proper rate [10 12/minute but not to exceed 12/minute] (1 point)

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NOTE: The examiner must now ask the candidate, How would you know if you are delivering appropriate volumeswith each ventilation?

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CRITICAL CRITERIA ____ After suctioning the patient, failure to initiate ventilations within 30 seconds or interrupts ventilations for greater than 30

seconds at any time ____ Failure to take or verbalize appropriate body substance isolation precautions ____ Failure to suction airway before ventilating the patient ____ Suctions the patient for an excessive and prolonged time ____ Failure to check responsiveness and breathing for at least 5 seconds but no more than 10 seconds ____ Failure to check pulse for at least 5 seconds but no more than 10 seconds ____ Failure to voice and ultimately provide high oxygen concentration [at least 85%] ____ Failure to ventilate the patient at a rate of at least 10/minute and no more than 12/minute ____ Failure to provide adequate volumes per breath [maximum 2 errors/minute permissible] ____ Insertion or use of any adjunct in a manner dangerous to the patient ____ Failure to manage the patient as a competent EMR ____ Exhibits unacceptable affect with patient or other personnel ____ Uses or orders a dangerous or inappropriate interventionYou must factually document your rationale for checking any of the above critical items on the reverse side of this

form.